Kinship Caregiver Home Assessment
Revised 12/2011
General Information
Location: Address, including county, Telephone number, and Directions to home
Identity of household members:
For each person living in the home, the worker includes the following: Name (include maiden name if different), Ethnicity of potential kinship
caregiver(s), Religion of potential kinship caregiver(s),Date of birth, Place of birth of potential kinship caregiver(s)( including state, city, county
and countr), Gender, Marital Status, Physical description including: estimated height and weight, hair and eye color, Citizenship/immigration
status of potential kinship caregiver(s), Military history, highest level of education achieved, Relationship to child, Primary language spoken
(include any other languages spoken), History of residence (document the length of time spent at each residence for the last 10 years, including
street address city and state, Social Security Numbers Do not include Social Security numbers in the printed home assessment that
is filed with the court and becomes public information. Social Security numbers are required for verifying information, but they must
not be printed.
Identify children to be placed (include for each): Name, Date of birth, Gender, History of residence,
Citizenship/immigration status
Summary of contacts: The worker identifies the following: The names of the persons contacted, The dates each person
was contacted, The types of contacts made (individual or group interview, conducted face-to-face, by phone, and so on), The
location at which each contact was made ***You must document all of the following: at least one individual interview with each of the
prospective caregivers; at least one individual interview with each child three years or older living in the home either full or part time;
at least one individual interview with any other person living full or part time with the family; a t least one joint interview with the
caregivers; at least one family group interview with family members living in the home; and at least one interview by telephone or in
person or by letter with any minor child 12 years of age or older or adult child of the prospective caregivers not living in the home. If
you cannot reach an adult child to interview you must document your reasonable efforts to locate that individual.
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Kinship Caregiver Home Assessment
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Safety: The worker addresses the following, when assessing the level of safety in a kinship caregiver's home. Issues identified in
the risk assessment. Complete and attach risk assessment to kinship caregiver home assessment. Include in the home assessment
any concerns that were identified in the risk assessment such as: Relevant background; Mitigating factors; Any efforts at
rehabilitation that have been undertaken; and other issues relevant to explaining whether the placement is safe in light of the risk
and safety-related concerns.
Motivation: Explain whether the kinship caregiver understands why the child(ren) was removed from the home. Include the
reasons the child(ren) was removed; Describe the kinship caregiver’s feelings and attitudes toward the child(ren)’s parent(s) and
other family members; Explain the kinship caregiver’s initial reasons for wanting the child(ren) placed in the home; Describe the
kinship caregiver’s feelings and attitudes about the potential for placing the child in their home; Describe the kinship caregiver's
understanding of and support of the permanency plan.
History of alcohol and drug use of kinship caregiver: Discuss the kinship caregiver’s history of drug or alcohol
use, if any. Discuss the kinship caregiver’s efforts toward rehabilitation, if any. Assess the kinship caregiver's ability to provide a safe
environment for children, if the caregiver reports a history of alcohol and drug use.
History as a victim of child abuse/neglect Discuss the kinship caregiver’s history as a victim of child abuse and
neglect, if any. Discuss the kinship caregiver’s efforts toward rehabilitation, if any. If kinship caregiver was a victim of child abuse or
neglect, assess his or her ability to provide a safe environment for children.
Checks of criminal history and CPS History: Ensure that all documentation has been obtained related to the criminal
and CPS history of all persons who live in the home and are 14 years of age or older.The documentation must include: whether a
CPS and criminal history exists; and whether the history operates as a permanent bar to adoption and adoption assistance or only
a potential bar that may be approved following a risk evaluation, if the kinship caregiver decides to adopt. See 6322.33 Conduct
and Evaluate Criminal History Checks on Potential Kinship Caregivers. Any questions about the consequences of CPS or
criminal history, must be discussed with the CPS supervisor before the home assessment is completed. In the case of a CPS or
criminal history that operates as a potential bar, the assessment must address concerns, background issues, mitigating factors,
rehabilitation, and any other issues relevant to the safety of the placement. Document the criminal and CPS history of all persons
who live in the kinship caregiver’s home and are 14 years of age or older. Discuss the caregiver’s future desires with respect to the
placement. Explain that if any person living in the home has a CPS or criminal history, the home may not be approved as an
adoptive home and the kinship caregiver will not be eligible to receive adoption assistance. Explain that approval to foster or adopt
or be eligible for any kinship financial assistance or Permanency Care Assistance also depends on whether the caregiver has
disclosed all relevant information to DFPS and on whether a CPS or criminal history emerges following approval as a kinship home.
Document the content of the discussions held with the caregiver, as well as the kinship caregiver’s reaction to the discussions.
Safety: Family Dynamics
Family Relationships (Including history of family violence): The worker includes the following
information about the family relationships when assessing a kinship home.
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Previous relationships. Discuss previous significant relationships and marriages. Describe the kinship caregiver's past
relationships, including how the couple met; the nature of their courtship; the circumstances surrounding their decision to marry, if
applicable; any history of family violence, and if the relationship(s) ended, how and why it ended and how any issues were resolved.
Current relationships (married couple). State the marital status. Describe the couples' interaction as husband and
wife. Include any history of family violence. Explain any separations and/or marital counseling. Address the couple's decisionmaking processes (including how the couple makes financial decisions) and how they handle disagreements. Explain how adding a
child(ren) to the household could affect the family. Describe the strengths and needs of their marriage, including the couple's and
the worker's perceptions. Describe the emotional support systems each spouse has outside of the relationship.
Couples with children. Address the issues noted above in Current relationships. Describe how the couple interacts as
parents. Explain the aspects of parental discipline that they agree on and disagree on. Explain how the couple resolves the
disagreements. Describe how they support one another as parents. Include any evidence of possessiveness, excessive control, and
so on. Include how the couple feels about themselves as parents. Describe whether the couple has realistic expectations of their
children and the children that may be placed in their home.
Single parent caregivers. Discuss the kinship caregiver’s support system. Describe any significant relationships the
caregiver has with both men and women. Include how the kinship caregiver feels about himself or herself as a parent. Describe
whether the kinship caregiver has realistic expectations for his or her child(ren) and the child(ren) that may be placed in the home.
Children currently living in the home. Ask the child(ren) who are currently living in the home about discipline (what the rules
are that are followed in the family, how they feel about the family’s decision to provide care to a relative child, and so on). Report the family's
and worker's perceptions. Observe and report on the child(ren)’s interaction with parent(s).
Other household members. Identify other household members, including any who live in the home part-time. Include the
results of criminal history and CPS checks on each person who is 14 years of age and older in the home.
Family Functioning: The worker assesses the following to determine how well the family functions,
when assessing a kinship caregiver's home.
Family rules and boundaries. Discuss the family's rules regarding expectations, responsibilities, division of labor, nudity,
privacy, and so on.
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Kinship Caregiver Home Assessment
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Handling stress and expressing negative feelings. Be specific in the assessment. Give examples of statements
and behaviors that support the assessment.
Kinship caregiver’s home. Address the potential kinship caregiver's ability to provide a safe home environment. Give
perceptions and assessment of issues where appropriate, giving examples. Describe the sleeping arrangements and whether there
is adequate space for children to play both inside and outside of the house.
Safety issues. Explain how the caregiver plans to keep the child safe. Explore the kinship caregiver's ability to protect the child
from the child's parents or other relatives who may pressure them to return the child to the parents or other relatives. Report the
caregiver's and worker's perceptions.
Discipline. Discuss the potential kinship caregiver's philosophy about caring for and disciplining a child. Describe the kinship
caregiver’s current methods of disciplining children. If the caregiver's current disciplinary practices are incompatible with DFPS
discipline policies, explain how the caregiver plans to reconcile the practices. Describe the caregiver's ability to support DFPS
discipline policy.
Child-care knowledge. Discuss the potential kinship caregiver's child-care experience, if the caregiver has no children.
Address the caregiver’s expectations of the child(ren) to be placed and the caregiver's role in helping the child meet the
expectations. Assess whether the expectations are realistic. Include examples of behaviors and activities that can help facilitate
discussions about how best to meet goals. Include the caregiver's expectations about visiting the child's school, monitoring the
child's performance in school, handling public displays of inappropriate behavior by the child , and so on.
Child management. Discuss the potential kinship caregiver's ability to manage the behaviors of children who have been
sexually or physically abused or neglected. Explore his or her ability to manage specific behaviors of the child, such as sexual acting
out, behaving aggressively, using abusive language, and so on.
Permanency: The worker considers the following, when assessing a kinship caregiver's home, to
determine a caregiver's ability to provide a child with a permanent home.
Child(ren)’s involvement with the kin caregiver (Include): Past and current contact with the potential kinship
caregiver. The child(ren)’s feelings about the potential kinship caregiver.
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Kin caregiver motivation Determine whether the potential kinship caregiver wants the child(ren) placed temporarily or
permanently and how this compares with the goals of DFPS. Report both the caregiver's and the case worker's perceptions. Explore
the how the potential kinship caregiver feels about allowing parental visitation and contacts. Include the caregiver's willingness to
cooperate with visitation, help develop and follow through on the child's service plan, help the child stay in contact with the child's
siblings and support the permanency plan. Report the caregiver's and worker's perceptions.
Kin caregiver health: Assess the potential kinship caregiver's physical, mental, and emotional health in relation to the
caregiver's ability to parent the child(ren) being placed. Include any diagnoses, medications and hospitalizations related to mental or
physical health. Discuss any disabilities the potential kinship caregiver has, the caregiver's adjustment to the disability, and any
limitations the disability may impose on the caregiver's ability to provide safety, permanency, and well-being to the child(ren).
Discuss and assess information about the couple’s fertility. The potential caregiver’s fertility is important only in relation to
unresolved feelings about infertility and their ability to accept and parent a child not born to them.
Well-Being: Consider the following when assessing a kinship caregiver's home to determine the potential
caregiver's ability to provide for a child's well-being.
Describe the following about the children to be placed: The child's placement history. The child's health
(include any health issues and health care needed). The child's level of success in school (include academic performance and
behavior issues). The kinship caregiver's ability to meet the medical, dental, therapeutic, social, and academic needs of the child.
Evaluate the kinship caregiver's attitude about the child(ren)'s religion. Discuss their willingness to respect and encourage the
child(ren)'s religious affiliation, if any; their willingness to provide the child(ren) opportunity for religious and spiritual development, if
development, if desired; and the heath protection they plan to give a child if the kinship caregiver's religious beliefs prohibit certain
medical treatment.
Children Who Have Been Physically Abused, Sexually Abused or Neglected: Address the potential kinship
caregiver's sensitivity to and feelings about children who may have been subjected to abuse or neglect. Include the caregiver's
understanding of how these issues and feelings will affect him or her, as well as the child(ren). Address the potential kinship
caregiver's ability to help a child(ren) who has experienced abuse and neglect.
Financial Situation: Identify the potential caregiver’s: employment history, income, expenses, ability to manage money.
Address the caregiver’s ability to manage the expenses of caring for the placed child(ren). Please include the income of all
individuals who reside in the home IF that income will be utilized to support the children. Discuss resources that may be available to
the kinship caregiver’s family that will help support the placed child, such as: child support, Medicaid, Temporary Assistance for
Needy Families (TANF), and other family members, etc.
Kinship Caregiver’s Support Systems:
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Kinship Caregiver Home Assessment
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Current support of kinship caregivers: Examine with the potential kinship caregiver supports he or she has available
through other family members. Discuss what community support services the kinship caregiver is aware of that he or she may have
access to.
Needed supportive services: Identify with the kinship caregiver the additional support services he or she may need to
provide for the child(ren)’s safety, permanency, and well-being; for example day care, tutoring, and training. Explain the extent to
which the kinship caregiver will use the family and community supports identified to meet the needs of the children.
References: Obtain five references: Three references who are not related and two related (In addition
to the adult children of the potential kinship caregiver).
Adult Children of Kinship Caregiver: Contact the kinship caregiver's adult children: Make an attempt to contact adult children.
Address comments made by adult children about the potential kinship caregiver's parenting style. Summarize positive statements and address
concerns raised by the adult child.
Summarize positive references: If the information provided by the potential kinship caregiver's references is positive,
summarize the information briefly and use direct quotes.
Address negative references: If information provided by the from the kinship caregiver's references raises any concern,
address the concerns.
Summary of Strengths, Protective Capacities and Concerns:
Summarize the potential kinship caregiver's strengths and protective capacities:
Summarize any concerns:
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Kinship Caregiver Home Assessment
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Recommendations: choose one of the following recommendations and explain why; recommend the
placement; or recommend the placement elsewhere
Erika, Add your signatures your lines here
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Signature of CPS primary worker requesting screening
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Date
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Signature of CPS primary supervisor requesting screening
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Date
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Signature of CPS primary Program Director requesting screening
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Date
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